Anand Utpal, Kumar Ramesh, Priyadarshi Rajeev N, Parasar Kunal, John Aaron G
Surgical Gastroenterology, All India Institute of Medical Sciences Patna, Patna, IND.
Gastroenterology, All India Institute of Medical Sciences Patna, Patna, IND.
Cureus. 2020 Sep 15;12(9):e10464. doi: 10.7759/cureus.10464.
Background The optimal management of gastric variceal bleeding in patients with non-cirrhotic portal hypertension (NCPH) is debatable due to the lack of data from large randomized controlled trials. Here we present our experience on proximal splenorenal shunt (PSRS) surgery in NCPH patients with bleeding gastric varices. Methods Over a five-year period, a total of 25 PSRS surgeries were performed and data was collected prospectively. Nineteen extrahepatic portal vein obstruction (EHPVO) and six non-cirrhotic portal fibrosis (NCPF) patients with bleeding fundic or isolated gastric varices and normal liver function were included. The collected data was analyzed retrospectively. Results Of the 25 patients who underwent PSRS five were lost to follow-up. Twenty patients (80%) were followed up for a median of 3.4 (1-5) years. Gastric variceal regression was noted in all 20 patients with the disappearance of varices in eight patients. On follow-up, shunt thrombosis was noted in four (20%) patients of whom, two had rebleeding between six months and three years after shunt surgery. Conclusion PSRS was effective in controlling gastric variceal hemorrhage in 92% (23 of 25) of patients with preserved liver function.
由于缺乏大型随机对照试验的数据，非肝硬化门静脉高压症（NCPH）患者胃静脉曲张出血的最佳管理存在争议。在此，我们介绍我们对NCPH合并胃静脉曲张出血患者进行近端脾肾分流术（PSRS）的经验。方法：在五年期间，共进行了25例PSRS手术，并前瞻性收集数据。纳入19例肝外门静脉阻塞（EHPVO）和6例非肝硬化门静脉纤维化（NCPF）患者，这些患者有胃底或孤立性胃静脉曲张出血且肝功能正常。对收集的数据进行回顾性分析。结果：25例行PSRS手术的患者中，5例失访。20例患者（80%）接受了中位时间为3.4（1 - 5）年的随访。所有20例患者的胃静脉曲张均有消退，其中8例静脉曲张消失。随访时，4例（20%）患者出现分流血栓形成，其中2例在分流手术后6个月至3年之间再次出血。结论：PSRS对92%（25例中的23例）肝功能良好的患者控制胃静脉曲张出血有效。
